The Osher Lifelong Learning Institute at the University of Utah offers a rich and evolving array of courses, lectures, and special activities for people who are 50 years of age and older. On 12/13/17 I was fortunate to be attending an Osher LLI Lunch and Learn. The keynote speaker was Dr. Greg Bulaj of the Medicinal Chemistry Department at the University of Utah. I was especially interested in his talk and had reserved a space well in advance as I expected the lecture to be pertinent to Therapeutic Harp work.

It was titled: Digital Medicine and Music for Epilepsy, Pain, Depression, and Cancer: How Mobile Apps and the Internet Deliver Non-pharmacological Therapies for Chronic Disorders.

Dr. Bulaj has been conducting research combining drug therapies with music and digital apps to improve the outcome for patients. As he began his lecture he informed us that one of the biggest healthcare challenges today is the fact that patients do not take their prescribed medications either at all, or sporadically, or incorrectly. According to research in the area of Medication Non-adherence, 50% of people with chronic diseases to not take their medications as prescribed. This can result in increased mortality and morbidity rates, reduced quality of life and shortened lifespans. The reasons for non-adherence vary including medications being too expensive, regimens too difficult to follow, patient denial of disease and need for treatment, discontinuing medication due to patients feeling well, and unpleasant medication side effects.

In the case of epilepsy, if meds are taken incorrectly seizure activity increases.

Blue Star: prescription digital intervention to treat Diabetes Type II. In clinical trials it was shown to be just as effective as medication. It is an FDA cleared mobile medical app and delivers behavioral self-management content.

MusicGlove used to treat stroke and traumatic brain injury, and Cerebral Palsy.

Project EVO videogame by Akili Interactive treats ADHD and Autism.

NeuroRacer videogame to treat and monitor cognitive decline.

Pain RelieVR: Virtual Reality device and software to manage pain.

ReMission: videogame for pediatric cancer patients.

Intellicare: A suite of apps for the mobile phone to treat depression and anxiety from the molecular level to the behavioral level. ‘A novel suite of 13 speedy mini-apps called IntelliCare significantly reduced depression and anxiety in study participants, who used the apps on their smartphones up to four times a day. The reductions of 50 percent in anxiety and depression are comparable to results expected in clinical practice using psychotherapy or with antidepressant medication.” https://www.sciencedaily.com/releases/2017/01/170105123102.htm

Combination therapy for cancer patients includes cancer drugs and the PE Game. Builds strength and improves positive attitude which can improve the immune system. The mobile game is loaded on a tablet and improves physical and mental empowerment and becomes an exercise device for patients.

Depression:

Packaging music into music streaming software to be used as a medical treatment. See published research paper below:

See UpMusing.net for use of music in treatment of depression and pain. upmusing.net/

Pain

Music and Physical Exercise are very effective in treating pain. Recommended treatment for chronic low back pain now is physical exercise, tai chi, or yoga. If no relief from this regimen after several months, then physicians may prescribe meds.

Fish oil (omega 3) can also be useful for pain management in combination with other modalities.

Epilepsy

Mozart Sonata K448 has been shown to reduce seizure activity in humans and rodents if performed per the original composition. 10 min/day seems to be an adequate amount of time for listening to be effective. It can also improve sleep and reduces stress. OK to listen to the music while sleeping.

If music is packaged in a mobile app, and approved by the FDA as a medical device, it can be reimbursable by third party payers

Dr. Bulaj’s final thoughts and comments:

“Alone we can do so little. Together we can do so much.” Helen Keller.

Digital Medicine may be efficacious as a preventive treatment because this is where behavior changes can most influence the disease outcome.

Challenges to Acceptance:

Cyber security fears

Power requirements

Patients willingness to be actively engaged in their own therapy

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After an enlightening discussion with Dr. Bulaj earlier this week he sent the following links for additional information related to his projects including harnessing medicinal properties of Mozart music for people with epilepsy.

Playing music for the hearing-impaired is a challenge. Unfortunately, a large number of hospice patients have lost much of their ability to hear well due to their advanced age. Until I can sit with the patient and try different sounds and gauge their response, I don’t know if therapeutic harp will benefit them or not. Sometimes, just the experience of trying to hear, agitates and frustrates the patient because it is a painful reminder that they’ve lost the joy of sound along with so many other deep losses. I have been dismissed by some with little regard for social graces and a lot of anger focused in my direction. In contrast, some profoundly deaf patients delight in the experience that someone went to the effort to lug a harp into their space and sit with them for awhile even though they will never hear a single note that is played. Intention and presence are gift enough for these people. One of my profoundly deaf patients once said to me, “Honey, I can’t hear at all anymore so you just play whatever you like. My wife enjoys the music and that makes me happy. Come back anytime.”

Yesterday I met a new hospice patient for the first time. John is in his 90’s, and when I arrived, he was quite agitated about something he thought was on his pants that needed to be removed. He was bent over double in his chair in his living room trying to pluck the offending substance off his pants. The printed pattern on the pants looked like something that didn’t belong there to him. His caregiver, a family member, was present and was concerned that John was not behaving appropriately for his “private concert”. He tried to reassure John that nothing was on his pants; John was not reassured in the slightest.

I had been informed before I arrived that John had 2 favorite songs that I should play which I practiced before I went. One, a traditional American song, the other a hymn. I introduced myself to John and shook his hand. He looked confused and asked, “Do I know you?” “Not yet” I assured him, “But you will.” I had to get very close and shout and it wasn’t clear if I was being heard at all. Initially, I sat about 6 feet back from the chair John occupied and began playing the songs a family member had told me he loved. I got no response. John had stopped fussing about whatever he thought was on his pant leg and now was agitated over the towel that he was sitting on to protect the chair. He wanted it removed. He kept trying to stand up so he could pull the towel out, which he wasn’t able to do without risking a fall. His caregiver kept jumping up and trying to calm John, encouraging him to just sit and listen to the music. John was having none of it and the caregiver appeared to be getting frustrated with John’s behavior. No matter how loudly I played, John was paying no attention to me at all. I was invisible to him. I suddenly realized John couldn’t see me or hear me. Clearly, this encounter was not producing the desired effect of soothing peace and calm for either John or his caregiver.

I stopped playing and told the caregiver I wanted to try something a little different. I moved as close as I could get to John with the harp and managed to get his visual attention. He did not seem to remember me and acted surprised that I was there. I placed his hands on the harp pillar and began to play scales, arpeggios, and glissandos. John’s face lit up. He could feel the vibrations. He began to comment on the size of the harp and the strings. He tentatively plucked a string and beamed his delight at me. He asked questions about the harp and told me about someone he knew long ago who played the harp. I was getting a glimpse of the charming, intelligent and caring man John was inside. He stopped perseverating on the chair and his pant legs. I tried again to play his favorite songs but there was no visible recognition to any melody from him. I continued to play familiar tunes, more to calm the caregiver than John. John appeared to find joy in the closeness and novelty of my presence and the harp vibrations he could feel. The caregiver found peace in the music and ability to relax, momentarily, from his demanding job. The tension in the room began to dissipate quickly as the calm settled. John kept his hand on the harp pillar and continued talking to me, quietly. I couldn’t understand his words so I just kept playing, looking at him, smiling and nodding. When it felt like the right time to leave, I bid John and his caregiver goodbye and was encouraged to return anytime, any day.

I was asked to present some Self-healing practices at our most recent Utah Therapeutic Harp Network (UTHN) gathering (a sacred circle). I have taken so many workshops and classes on the following list but can not claim any expertise. I’ve tried them all and to some extent they are all useful and easy to do. We did some of the exercises at our meeting and I think everybody felt more open and less stressed at the end. I know I did. Then, of course, we ate a fabulous lunch prepared by our awesome hostess, Peggy. Felt like a day at the spa.

What makes all of these practices most beneficial is habit. They should be practiced on a daily basis, not just when you’re depressed or stressed, in order to build resilience. Yeah, right. Do what I say, not what I do. Youtube video references are included for more in-depth explanations and demonstrations. I tried to find the best for you.

Self-Healing Practices to Stay Healthy and Creative

1. MUSIC: Listen, play, sing and tone your chakras
If you’re feeling overwhelmed by a stressful situation, try taking a break and listening to relaxing music. Playing calm music has a positive effect on the brain and body, can lower blood pressure, and reduce cortisol, a hormone linked to stress. (Did I really need to remind a roomful of Therapeutic Musicians this?) Ocean or nature sounds have similar relaxing effects as music. So does singing and it improves your oxygenation levels if you do it right.Exercise: Tone your Chakras. As you sing the vowel sounds, hold the place where that chakra resides in the body and see if you can feel the vibration there. https://www.youtube.com/watch?v=F8kwc1lkiAQ every video has different vowel sounds. If the following don’t work for you, try another one.

2. Call a friend (another UTHN member)
When you’re feeling stressed, take a break to call a supportive friend and talk about your problems. Good relationships with friends and loved ones are important to any healthy lifestyle, and they’re especially important when you’re under a lot of stress.

3. Talk yourself through it (EFT)
Sometimes calling a friend is not an option. If this is the case, talking calmly to yourself can be the next best thing. Don’t worry about seeming crazy — just tell yourself why you’re stressed out, what you have to do to complete the task at hand, and most importantly, that everything will be okay. Remind yourself of all the challenges in life you have already overcome successfully. Or try the
Emotional Freedom Technique technique https://www.youtube.com/watch?v=XyHxuTG6jRk with self talk and tapping.

4. Eat Right
Stress levels and a proper diet are closely related. When we’re overwhelmed, we often forget to eat well and resort to using sugary, fatty snack foods as a pick-me-up. Try to avoid sugary snacks and plan ahead. Fruits and vegetables are always good, and fish with high levels of omega-3 fatty acids have been shown to reduce the symptoms of stress. A tuna sandwich really is brain food.
Drink Green tea rather than caffeinated drinks A large dose of caffeine causes a short-term spike in blood pressure. It may also cause your hypothalamic-pituitary-adrenal axis to go into overdrive. Instead of coffee or energy drinks, try green tea. It has less than half the caffeine of coffee and contains healthy antioxidants, as well as theanine, an amino acid that has a calming effect on the nervous system.

5. Laugh it off—yoga laughing
Laughter releases endorphins that improve mood and decrease levels of the stress-causing hormones cortisol and adrenaline. Laughing tricks your nervous system into making you happy.
Can’t think of anything funny? Go to Youtube and look for Monty Python, Robin Williams, Carol Burnett or whoever has made you laugh in the past.
Fake it. Just start belly laughing. This will be enough for your body to respond biochemically. And you will soon be laughing for real at how silly you sound. Did you know there are Laughing Yoga clubs all over the planet?https://www.youtube.com/watch?v=5hf2umYCKr8

6. Exercise (even for a minute) Qi Gong and Qi Self Care
Exercise doesn’t necessarily mean power lifting at the gym or training for a marathon. A short walk around the clinic or neighborhood, or simply standing up to stretch during a break at work can offer immediate relief in a stressful situation. Getting your blood moving releases endorphins and can improve your mood almost instantaneously.
Open the Meridians with tapping and movementhttps://www.youtube.com/watch?v=FjQJYAk97ns

7. Sleep better (banana tea)
Everyone knows stress can cause you to lose sleep. Unfortunately, lack of sleep is also a key cause of stress. This vicious cycle causes the brain and body to get out of whack and only gets worse with time. If sleep is a problem, try turning the TV off earlier, dim the lights, and give yourself time to relax before going to bed. It may be the most effective stress buster on our list. Kristen shared a recipe for insomnia, make banana tea: cut off the ends of a ripe banana and boil it for 10 minutes. Drink the water as tea with some cinnamon. : https://www.davidwolfe.com/banana-cinnamon-tea-deep-sleep/

8. Breathe deep and think of things you are grateful for
For centuries, Buddhist monks have been conscious of deliberate breathing during meditation. This is also the foundation of HeartMath’s formula for improving Heart Rate Variability and increasing resilience. Sit up in your chair with your feet flat on the floor and hands on top of your knees. Breathe in and out slowly and deeply, concentrating on your lungs as they expand fully in your chest. While shallow breathing causes stress, deep breathing oxygenates your blood, helps center your body, and clears your mind. While you’re breathing, focus your mind on the things in your life you are grateful for. 3-5 minutes every day, longer if you don’t think you have time to do this. https://www.youtube.com/watch?v=d4QtkV3UgDY and a guided meditation:

9. Morning Pages, The Artist’s Date, Sacred Circles: Purpose: to declutter your brain and banish blocks to creativity and living a full and abundant life. All of this is from the book, The Artist’s Way by Julia Cameron. If you read this 20 years ago, like me, read it again. I got so much more out of it the second time.Morning pages: Every morning before anything else, sit and fill 3 pages of handwritten stream of consciousness. Do not review it, do not edit it. Just brain dump onto the paper. https://www.youtube.com/watch?v=oxtEo4yCOh4Artists Date: Make a date with yourself to do something that you really enjoy, honoring yourself and what it is you do that makes you unique on a regular basis. What is fun? Can you do it alone? Do it. Is there someone who would enjoy doing it with you not just out of obligation? Invite them.Forming a Sacred Circle—”Success occurs in clusters and is born in generosity. Let us form constellations of believing mirrors and move into our powers.” J. Cameron. This is what UTHN is, our sacred circle.

I returned recently from the International Harp Therapy Program workshop in Cedar Falls, Iowa and the follow up experiential workshop on Resonant Tone in Albert Lea, Minnesota. While I wasn’t looking forward to traveling to the mid-west in August from all I had been warned about: sweltering heat, oppressive humidity and bugs; none of that proved to be the case, at least while I was there. The weather was agreeable, even cool and rainy and the bugs stayed home. It is always inspirational and validating to come together with the IHTP tribe of Therapeutic Harpists, including new students, former teachers, experienced practitioners, and old friends. We speak the same language and have shared experiences. While all presentations at this weekend conference were valuable and informative, my favorite takeaway from this session was the Aromatherapy Workshop. I use aromatherapy with patients by dabbing it on my wrists. The movement of my arms while playing harp sitting close to the bedside then sends it subtly into the room. My favorite blend is from Young Living Farms called Forgiveness. It includes sesame seed, melissa, geranium, frankincense, sandalwood, coriander, angelica root, lavender, bergamot, lemon, ylang ylang, jasmine, Helichrysum italicum oil, Roman chamomile, and rose.

It is useful when people are at the end of life and can’t seem to let go because of anger, bitterness, resentment, guilt and fear. And I love the smell.

Pamela, my new IHTP sister, friend, and roommate for both workshops, acquired a room spray of Frankincense to help us sleep and ground us while we were there from Rodney Schwan, which she liberally spritzed every night before bedtime. It seemed to do the trick. Rodney is a Massage Therapist and Aromatherapist who works in the field of palliative care. The knowledge and personal experience he shared about using various scents in palliative care use was extremely valuable and which I intend to include more of in my own practice.

On Saturday night, Gaylord Stauffer, Cedar Falls host, harpist and gardener extraordinaire, invited us all to his home. The following pictures are from his incredible gardenscape, where we were able to wander and wonder at our leisure while our friends played harp and sang into the evening. Good food, good company, and incredible creative landscape artistry created a magical environment for us all to refresh and relax.

Albert Lea and ESM Workshop

“ESM – Experiential Specialty Module – The Experiential Specialty Module requires in-person attendance for all students. This is a week long Module. The ESM is scheduled at venues in many countries, and you can take it anywhere it is offered. This allows the program to be quite flexible and moderately paced for all students. The Experiential module (which is an extension of Unit 4) enables the student to be ‘recommended for Hospice work,’ as opposed to those who only take the theoretical Unit 4 about Resonance.” (http://harptherapycampus.com/campus-2/faqs/).

Diane, Pamela, Sharon, Heidi

There were four of us in this training:

From left to right: Diane from Idaho, Pamela from New York, Sharon from Edmonton, CA, and me. Included is Sharon’s Stony End harp which we all got to play one evening in the hotel lobby for our own amusement and that of the hotel staff and guests while it poured rain outside.

Being such a small group with 2 fabulous instructors: Christina Tourin and Judith Hitt, allowed us to really go deep into the training which was so appreciated by us all.

Having gone through the theoretical ESM training seven years ago, much was review for me but the experiential resonant tone was practice-changing for me.

The concept of resonant tone is based on the fact that we all vibrate, and that which vibrates, produces sound. As Therapeutic Harp Practitioners, we must be centered, focused and attentive to our patients and their surroundings, integrate that information and meet the patient where they are at within that moment vibrationally, emotionally, and mentally. Any vocalizations produced by the patient provide a clue as to their resonant tone which we try to match with our musical selections. Items in the room provide clues to their interests and personality and whatever they are willing to share with us in that space also helps. Being open to all of this and completely focused on the patient allows intuition to assist with the choices. Some of my colleagues refer to this as “the voice”, “Creator”, spirit guides” “universal intelligence” and “pure coincidence”. Whatever the source for an idea that comes to us to play a particular tune or improvisational mode for a patient that is absolutely perfect, it will come to us if we are open to it, paying attention, and grounded in our intention to do the best we can for the person we are with.

Watching the response of the patient to our musical selections, key, rhythm, genre, allows for opportunities to change and select a more appropriate choice to connect with the patient as needed.

At the end of the week we gave a performance for the residents of the facility which had provided a beautiful space for us all week. Then we traveled to a different facility where we were allowed to shadow Christina and Rachel Christianson, IHTP graduate, amazing harpist, and local host for our training, as they provided Therapeutic Harp music for selected patients. They used harp, voice, conversation, shared experiences to establish that special connection for the patient and their families within a limited amount of time. There is no way to glean the benefits of this level of training without being present and experiencing it first hand.

At Rachel and Dave’s house Tina and Rachel jamming on the Heartland harps

Another dinner party, this time hosted by Rachel and Dave Christiansen of Albert Lea, MN at their lovely home on the lake. From L to R: Tina, Judith, Pamela, Sharon and Diane.

I have been able to develop a new depth to my own practice of bedside playing for hospice patients because of what I learned in both of these workshops. It was well worth the time and money to participate, expand my skills and work outside my comfort zone with such incredibly talented and dedicated professionals.

Sometimes I don’t arrive in time to play for the actively dying patients before they pass. If the mortuary has not come yet, I may sit with the body in a low-lit room and play for the newly departed. My personal belief is that the newly dead remain in the former space for a short period of time. Like birth, the end of life transition from mortal to spiritual being can be traumatic and confusing, initially. I imagine the abrupt cessation of pain, gravity, and fear when the spirit finally releases the physical shell, combined with the impending launch into the light of unconditional love with the soul family and Creator, may cause some momentary resistance, at least for some. So, I play for that spirit who may remain, encouraging it to take flight. I play for the hospice staff and family members who remain in the room grieving their loss. I play for the facility staff who clean and prepare the body for the mortuary to pick up and are mourning, as they complete this final service for a patient they have come to know and love. This is a sacred space and time and I feel a responsibility to hold and preserve that sacredness for just a bit longer with music if I can.

Rudy was a patient who was loved by everyone he met throughout his life. He came to America as a poor Russian immigrant when the Soviet bloc collapsed in the 1980s and he could leave Mother Russia. He brought his family with him including his wife and several small children and was a man who made friends wherever he went. According to one son, Rudy never forgot his old acquaintances while continuing to make new friends his entire life. How he remembered all those people, their names, the details about their families and lives was a mystery to everyone, including Rudy’s own family.

Rudy’s final days were spent on hospice in an assisted care facility he had been living in for a while. Even before Rudy was admitted to hospice, I knew him. He had met me when I came to play for our hospice patients at the facility and we had spoken in the lobby while I tuned the harp and he was waiting for his daughter to come and visit.

When I first entered Rudy’s room with the harp, he looked up and smiled. “Well, I guess it must be my time, the angel has come for me, now”, he said. He remembered who I was from our prior brief meeting. I told him I hoped we would have many therapeutic music sessions together. He just shrugged, leaned back in his wheelchair, closed his eyes and let the music envelop him. We did get to have many sessions together but not as many as either of us would have liked. I remember him always smiling and welcoming me into his room even as his diminished health steadily declined.

I was unable to be there with him while he was actively dying but I was told he was surrounded by his loving family and friends. By the time I arrived at the facility to play for him, Rudy had passed and his family had left so I sat in his room with his body and played some of his favorite songs. Soon the Nursing staff came in to prepare Rudy’s body for the mortuary. I asked them if I could stay and continue playing while they worked. The two Aides agreed although my request seem to surprise them. Both were tearful while they lovingly bathed Rudy and covered his body. Rudy’s departure would leave a large hole in the world for all the people whose lives he had touched.

When the mortuary came for Rudy, his body was carefully transferred to the gurney and his face covered with a drape. A rose was placed on his body and the processional to the waiting van began with the hospice nurse, the 2 mortuary staff people, and the gurney with Rudy. The nursing assistants and I walked behind out to the waiting car. I believe Rudy’s spirit had already departed by then. I played only for his memory and for the people he had left behind to comfort us all in our grief.

I had been alerted through encrypted email that one of my favorite VA patients had passed after a long time on hospice. I had gotten to know Joe well during our sessions together as he did not suffer from dementia and loved music. Usually welcoming and greeting me with a big smile, the last time I visited he asked me to leave as he just wanted to sleep. I knew he wouldn’t be with us much longer.

The next time I saw him, he had passed. He was still in his facility bed and room and his family wanted to provide a memorial for him there and dispense with a funeral service. They planned a bigger family and friend memorial much later in his home. Joe would be cremated. A rose was placed on his body and I sat next to the bed as far back as I could get in very tight quarters to accommodate family who wanted to say “Farewell” and touch him. As they slowly filed in, I played hymns and music he had enjoyed. Although no program had been formally planned, at one point a son began telling stories about his dad from a happier time. In addition to being a kind, generous, adventurous man who loved the outdoors and his family, he had also been a Gin and Tonic drinker. Neat, no ice. As the family stories began to unfold of trips to Moab and Lake Powell and skiing, there was equal laughter and tears. Everybody, including teenage grandchildren at the time, had been encouraged by Joe to join him in his favorite drink. As they told it, mostly gin, little tonic, warm and disgusting but they drank with him anyway to please him. And to honor him, an adult grandchild pulled out of his pocket a flask of gin and a small bottle of tonic water. Paper cups were gathered and a toast was drunk to Joe, beloved husband, father, grandfather and friend. After everyone was done speaking I played some more and stayed until the mortuary arrive. I finished with You Raise Me Up, Wind Beneath My Wings, and Somewhere Over the Rainbow. I waited outside the room while the mortuary transferred Joe to their guerney, draped his body with the American flag and began the processional out to the waiting van.

At this VA long term care facility, the dead are acknowledged and honored. As they are slowly moved out in a great processional with the nurse, chaplain and family following the departed, over the loudspeaker everyone in the building is informed of their passing, their military service and a recording of Taps is played. All who can, stand and either salute or place their hand over their heart until the veteran moves out the door. All work and conversation that is not essential stops. It is a very moving experience just to be part of this loving and final tribute to people who selflessly served their country.

I realized that I might have overdone it that day when I pulled into the grocery store on my way home from work at 7:30 pm on a Friday night. Instead of buying some nice, sensible salad fixings for dinner, or even a pre-made comfort meal from the deli, I bought a pint of cookie caramel crunch gelato and a tiny little jar of Nutella. Oh, and some salty, crunchy, calorie-dense, nutrient-poor condiments and side dishes to enhance the main course. This is what I ate for dinner while I binge-watched Glee reruns on Netflix. Predictably, by bedtime I was suffering from bloat remorse and a bit of queasiness. I confess, this is how I self-medicate.

The day started with me getting a late start on a one hour drive for a Mother’s Day lunch harp gig, only to discover when I arrived (after breaking speed limits without getting caught) that the lunch actually started an hour later. Since I was at a long term care facility, I had patients there to see anyway. I went first to the one patient who I had read via email was probably transitioning. I sat by his bed and played ionic, rhythmic improvisations in mostly major keys. I threw a couple of hymns in as well. I could not detect any sort of outward physical response to the music. For all intents and purposes, the patient appeared relaxed, calm and sleeping like a baby. I moved on to patient number 2 who was sitting in the dining room waiting for lunch. I played for him until it was time to gravitate to the Mother’s Day lunch celebration. I was put on the stage with a spotlight and microphone and played my heart out for an hour and 15 minutes. That is about my limit, without a break. When I reach that point of “so-done”, I start making a lot of mistakes. The brain begins to go first, and the fingers aren’t far behind, similar to hypothermia effect. It’s best to stop while people still think I’m a fairly good harp player. Fortunately, the facility staff in their gratitude for my serenade offered me lunch which was reviving as only lasagna, salad with raspberries and cupcakes frosted to look like flowers can be. I proceeded to see and play for another 4 patients at the facility.

My email alerted me as I was finishing up that there were no less than 3 patients I knew well who were transitioning to actively dying at a facility I would be driving right past on my way home. I felt compelled to stop and play for them and their families, if there were any family members present.

Before I got to anyone’s room, I ran into one of our hospice chaplains. He confirmed that there were three of our patients in various stages of dying, none of whom were expected to last the weekend. I assured him I intended to see them all before I went home.

The first patient I saw at the facility, patient #7 for the day, was lying in bed with open, unseeing glazed eyes and death rattle breathing. Her roommate had not gone to dinner and was lying in bed watching TV, which she blessedly turned off after I arrived and began to play. I am always so grateful for this thoughtfulness in shared space. No matter what someone’s financial situation is, they should be allowed to die in peace and not have to listen to the dreadful evening news or Jeopardy blasting 10 feet from their bed. So often though, they are left in a shared room where the roommates are doing their best to ignore the fact that one of their own is dying, while family and friends are present and grieving around the bedside. If there is space available, sometimes the nearly departed and entourage are moved to a private room but often, there is no space available and everybody must suffer together.

I played chord progressions with right hand improvisations, including both major and minor keys, the Kyrie Eleison from Hildegard Von Bingen’s Missa De Angeles written in the 11th century and pentatonic improvisation with some standard hymns thrown in. Finally, the patient closed her eyes and appeared to fall into a deep sleep. Her breathing was still audible and wet sounding but not so loud and labored as before. I left her quietly and went to see my next patient.

Patient #8 was surrounded by children, grandchildren and a young great grand-child. This room was also shared with another patient hiding behind a thin curtain surrounding her bed. A son told me that his mother loved music and came from a musical family. I had been playing for the patient for a couple of years as she slowly declined but she had never been able to communicate with me beyond gibberish, moans and cries. She had severe dementia in addition to co-morbidities so while I knew her, I never really knew her at all or who she had been before she became a hospice patient. The patient was sleeping peacefully and I didn’t know that I had much to offer her. However, the family was in the throes of grief and their pain and agitation was very real. I find that familiar music and hymns seem to help in those situations. I extended the repertoire with improvisations but I focused on standard hymns, finishing with Somewhere over the Rainbow, You Raise Me Up and Wind Beneath my Wings. More family arrived and I departed to make space for them and to see my third patient.

Patient #9 was a dementia patient who was blissfully alone in her room. There were no other patients or family with her at that time. Prior to her recent health decline, she used to love to sing along when I played harp for her. Even in her current state, she was still humming, very quietly, while she lay in bed with her eyes closed. I began with her favorite songs and then shifted to unfamiliar music and then improvisations. She continued to hum along anyway. When I left, she was still humming some favorite tune only she could recognize. She did not appear agitated or uncomfortable, which had been the case earlier, according to the nurse’s report.

I did not notice my own exhaustion while I played for our patients but after I finished it hit me. As did the pulsating neck pain radiating up into my head. I still had an hour drive home after seeing the last patient but at least the commuter gridlock traffic had abated by then. Good thing, because I think I drove on autopilot most of the way. That is, until I got close to the grocery store and began obsessing about ice cream and Nutella. Eight hours of Therapeutic Harp playing is too much, at least for me. But sometimes things happen and there is no real choice in the matter. You do what needs to be done; then go home, eat ice cream, watch Glee reruns, and hope tomorrow is better.

I am so grateful I get to witness miracles on a daily basis. And they usually happen when I have no expectations. Last night as I was leaving a facility, the Hospice RN asked if I had played for a patient of ours who was transitioning. I replied I had not and then explained, I no longer played for him since he had moved into a 3 patient room with a roommate who was so unpleasant whenever I came into the room it made it impossible to play harp and promote relaxation and peace. Typically, what would happen would be that I would knock and enter the room with my harp. The unpleasant roommate (let’s call him UR) would snarl, “I don’t want what you’re selling!” I would smile and say, “I’m not selling anything and I’m here to play for your friend over there and you’re welcome to listen.”

He would shout, “I don’t want to listen, I’m sick of all you people.” And would turn on or turn up his TV to an ear-splitting level. No amount of persuasion or negotiating could get him to turn his TV down or off. It was impossible to play over the noise so I finally just gave up and avoided that room altogether. UR never left the room for meals either so he couldn’t be worked around. It was unfortunate because, before our patient had been moved into that toxic environment, I had played for him successfully for months.

Back to the present. The RN reminded me, “You know, our patient (OP) is transitioning”. I sighed and told her I did know that and I would go in there and see what I could do but I wasn’t hopeful because of the unpleasant roommate situation. She understood my dilemma.

I knocked on the patient’s door and was welcomed with “Come in!” I opened the door and was surprised the TV was not on and UR was sitting up in this recliner and dressed. I greeted him and asked if he had eaten dinner yet, as it was 5:30. He said he had eaten something although it wasn’t very good. There wasn’t a trace of hostility in his voice and he was actually responding almost pleasantly to my conversation. Unbelievable. I had the harp with me and he may have remembered me from our past encounters. I told him, “I’m going to sit with OP and play quietly by his bedside. I will try and not disturb you”. He nodded. I waited for the TV to be turned on as was typical, but it didn’t happen. I was allowed to play quietly by OP’s bedside while he slept and the room remained silent except for the harp and the soft white noise of the oxygen equipment. After awhile, some visitors came in to visit with UR and I heard him tell them that his roommate was dying and to “Keep it down”. They encouraged him to come with them to an activity in the patient lounge area and he agreed. I had never known UR to leave that room in the past, for any reason.

I played all of OP’s favorite hymns and the song his wife had asked me to play for him before she died earlier that year which was their favorite: Clare De Lune. I told OP, “Your wife is waiting for you. You can go with her whenever you are ready.” I’m confident OP’s wife was with us at that moment patiently waiting for him to take her hand and cross over to be with her. OP passed the next morning, peacefully.

When I shared this story with my supervisor the next morning after hearing OP had died she sent me this note:

“Thank-you for the intuitive sense that you needed to play the harp for him. I’m sure that it meant a lot to him especially if you played “Stairway to Heaven”. You are phenomenal and I’m so glad that you were there yesterday. In hospice, there are no coincidences but rather small miracles and whisperings from Heavenly Father. Heidi, there is a reason that you are with our hospice because you are a gift sent to us!! So thank-you again for the amazing talent that you provide for the patients!”

For all the employee reviews I have ever received (both the glowing and the not so good ones) over a 30+ year career, this is one I will always cherish for making me feel truly valued. Bless you, D!

As a Therapeutic Musician, usually I play for patients while they passively listen to the music and relax to the gentle sounds. However, on rare occasions I get to make music with my patients, which takes the experience to a much higher vibrational level of healing.Sometimes we sing together but in the following case, my patient was a harmonica player, not a singer.

Kevin* was referred to me by our hospice team for Therapeutic Harp sessions to help with his anxiety associated with dementia. I was told at that time that Kevin was a musician. Bristol Hospice recognizes the benefits of live, bedside harp music to calm patients and family members in our music program.In my experience, people with musical talent are especially receptive.

Kevin lived in an assisted care facility. The first time we met, I found him sitting in his private room watching tv. Well, the tv was on; whether he was watching it or not was debatable. On the table next to his bed was a large harmonica.I didn’t know much about harmonicas at that time but when I asked Kevin about it, his face immediately lit up with a big smile. He said he had been playing harmonica since he was 3 years old.His older brother had one and when his sibling left for school, Kevin “stole” the harmonica and has been playing one ever since. He was proud to relate he is self- taught and plays by ear.

I started to play an unfamiliar Celtic tune on the harp for him to initiate the musical relaxation session. But Kevin did not want to relax to my music, he wanted to play music with me. I had never had this experience before so I stopped and asked him what song he would like to play and he said, “Anything in the key of C because that is all this mouth organ can do.”He said he couldn’t remember any songs by name but if I would start playing something popular, maybe he would remember.I began with “Amazing Grace”.He cocked his head and listened briefly and then informed me he recognized the tune although couldn’t remember the title and I was playing it in the wrong key.It took some trial and error but I was able to transpose the piece into the “right” key and we were able to play our first harp and harmonica duet: Amazing Grace, key of C major.

The next time I came to play for Kevin, he was sitting in the lobby of the facility with the other residents waiting for dinner.I had planned to go to his room as we had done previously but several of the other residents asked us to stay in the lobby and play when they saw my harp.Kevin agreed to play with me in the lobby so we began the first of our pre-dinner performances for the residents.The fact that we didn’t always play the “right” notes or finish at the same time didn’t bother anyone.The happy sound of Kevin’s harmonica and the beautiful tone of the harp brought joy to everyone in the lobby, especially Kevin.

As soon as someone recognized a tune we were playing they would call it out, which began a game of “Guess That Tune” for the residents. Occasionally, someone would join us by singing along, which added to the fun. At the end of each session, Kevin would whisper to me, “Not bad for an unrehearsed first time effort. Maybe we should practice a bit next time.”

Kevin’s hospice nurse was in the audience one afternoon and told me after our performance that he was profoundly moved by the transformation Kevin went through simply by bringing a harmonica to his lips and making music. “It was like Kevin came to life!” the nurse said. “I can’t believe the change in him just by performing music.”

Kevin and I routinely performed at the facility every other week, same time, same day, before dinner and entertained the residents with our music.Kevin’s family was visiting him at one of our sessions and they were amazed at Kevin’s musical talent as well as the change in his demeanor when he began to play. “It’s like he got younger in front of our eyes!” his relative exclaimed.“I didn’t even know he played the harmonica,” she added. “I’m going to try and organize a family jam session with him,” she promised.

In order to understand Kevin’s musical transformation, I should describe his before and after effect. Upon arrival at the facility, I would see Kevin sitting in his wheelchair across the lobby, withdrawn and isolated.He had slight hearing loss, poor eyesight and memory loss which made participation in the group verbal activities and games the facility organized difficult for him.His face would be blank with a flat affect.I would greet him and ask him if he would like to play harmonica with me, and he would smile and begin searching for his harmonica.It usually was in his room on his table, not in his pocket.After retrieving it I would ask him what he wanted to play. He would respond, ”I can’t remember any music except the Yale Fight song and a good old Baptist hymn, Love Lifted Me”.I would encourage him to play his songs for us and then we would all clap, which tickled him. After his solos, he would turn to me and say, “I can’t think of any other songs. You play something. I’ll join you if I can remember it.”I knew the songs he would remember and could play on his harmonica so I would begin on my list.Within 4 notes, he could usually join in and we would play together.Often, Kevin added interesting harmonies and counterpoint to the melody.When we finished and everyone applauded, he would whisper to me, “Not bad for a first time effort”.At the end of our session when the residents begin wandering into the dining room for dinner, Kevin would look at me and say, “Maybe next time we should practice before we perform,“and then he would ask “Who are you, dear?And I would always say, “ What a great idea. My name is Heidi and I work for Bristol Hospice and I’m here just to play with you.”

“Oh, how nice!” he would respond and then I would wheel him into dinner and depart.

Kevin and I played together every other week for almost a year before he passed away, rather suddenly, as I know he would have wanted it. While his family sat at his bedside during his transition, I stayed outside his door and played all of our favorite songs to help him on his journey.

*Kevin is not the patient’s real name, which is changed to protect his privacy.

“I believe things happen for a reason. I just don’t know what it is yet.” During a dark period of my life, crying in my therapist’s office, I actually uttered those words of hope. It surprised us both. That was over 10 years ago and I am only beginning to see the connections and purpose of events that guided me to the here and now, a far better place.
I attended a seminar this week focused on “How to deliver your message”. It was really a 3 hour introduction to a 3 day workshop the presenters wanted to sell to us. They offered some useful tips on how to really define our personal meaning of life. Everyone quotes Victor Frankl when delving into the domain of meaning of life (how can you not?) If you don’t have a life purpose, a calling, and recognize it, you’re survival odds during adversity, are not so good. Frankl watched this theory be proven time and time again at Auschwitz concentration camp during WWII. He survived because he knew his purpose was to tell the world the story of Auschwitz, lest the truth never be told. Over time he learned his life had greater purpose than just that one. He has helped millions of people find their true purpose and understand the value of that.
When you know your purpose, you can help other people find theirs. During the seminar one of the exercises we did was to work with a partner, the person sitting next to us who we had never met before. We each had 3 minutes to listen to the other tell us their life purpose without questions or interruption. When they stopped talking, we could only repeat the question, “What is your purpose?” as they peeled away the layers of their profession, their livelihood, their lifestyle, their goals, to get to the heart of “What is your purpose?” It was not an easy exercise, especially for my younger partner who really hadn’t thought about his life purpose. He told me about his company and how it provided a good lifestyle for him and his family and how he came to founding it and where he wanted to take it. But none of that really addressed his true purpose. I suspect that long after the seminar, he will be pondering the question and how to best address it. Because, when you find your purpose, or calling, invariably, you realize it isn’t about you at all. It’s about how you can serve others.
I can’t remember my exact words during the 3 minutes I had to talk but I’m pretty sure I focused on my perceived calling of playing harp for hospice patients to ease their transition from this life to the next. It didn’t occur to me until after the workshop that there might be a deeper layer, when I later made a connection between the seminar and an encounter I had with a woman earlier in the day at a long term care facility. Not all the residents at facilities where I play are in hospice or need to be, and over time I get to know some of the others. That day, I had finished playing for my patients and was preparing to leave so that I could get to the seminar on time, about an hour away in rain and commuter traffic, a bad combination for a timely arrival. There was a group of people visiting in the lobby area, patients and family members, where I paused to get organized before running to my car with harp, gig bag, stool and keys. A young woman in a wheelchair in the lobby stopped me and asked if I would play something for them before I left. Although I was in a hurry to leave I agreed. I played Somewhere Over the Rainbow followed by What A Wonderful World. When I finished, the young woman who had requested I play asked, “How long have you been playing the harp and why?” I told her, “Over 20 years and it’s my calling to do this work with hospice patients. It helps them relax and sometimes be better able to face what is next.”
She thought about that quietly for a moment and then said, “You know, I wonder about what my purpose is, especially after the accident now that I’m stuck in this chair. I think my calling may be about helping people cope with bullies. I get so upset when I read or hear about people being bullied I just want to do something to help them!” There was real passion in her voice, a good indicator for recognizing your purpose. Passion is an essential ingredient.
“Sounds like a good purpose”, I commented. We chatted a while longer and then I left because the rain had stopped momentarily. I did not know then that the seminar would focus on purpose. I thought it was about helping people be better public speakers. Actually it was both of those things. However, those two events in one day got me to think more about my purpose. Victor Frankl had a primary purpose that he credits helped him stay alive in the worst possible situation any human could endure. He went on to live a life where his purpose became greater as a psychiatrist and author who helped far more people than he could have imagined by sharing his story.
Another musician’s story that I find truly inspiring is that of George Flores, a quadriplegic former rock and roll performer who became a harp builder of some fame. If you aren’t familiar with George’s story, the following is a brief video about him. https://www.facebook.com/GeorgeHarps/videos/1195973339065/

Story telling is a powerful transformative tool of the universe with a wide ripple effect. So is the harp.